The Challenge - PowerPoint by liuqingyan

VIEWS: 7 PAGES: 40

									        Hand Arthritis
• Rheumatoid Arthritis
   Rheumatoid Arthritis
•Definition
 –Tenosynovitis
 –Joint
  Deformities
 –Systemic
  Illness
     How to Recognize
•(+) RF and ESR
•X-ray pattern of
 destruction
Office Management



           •Adaptive
            Devices
           •Night Splints
        Tenosynovitis
•Causes tendon
 rupture
•Pattern ulnar to
 radial
       When to Refer
•Tenosynovitis >
 3 mo.
•Extensor lag
         How We Treat It
•Early
 Tenosynovectomy
•Late Tendon
 Transfers
    Tendon Transfers
•Resect DRUJ
•Synovectomy
•Tendon
 Transfers:
       Tendon Transfers
Tendon Ruptures
• SF EDC: EDC IV to
  V
• SF+RF EDC: EIP to
  IV and V
      Tendon Transfers
Tendon Ruptures
•3 or More Digits:
 Tx FDS to EDC
  MCP Joint Deformities

•Ulnar Drift
•Volar
 Subluxation
    Office Management

•Night Splints
•Medical
 management
       How We Treat
•MCP joint
 arthroplasty
MCP joint arthroplasty
MCP joint arthroplasty



              Preop   Postop
   PIP Joint Deformities

•Swan Neck
•Boutonniére
•Joint Destruction
          Swan Neck
•PIP joint
 hyperextends
•Volar plate
 laxity
•Lateral bands
 sublux dorsally
          Boutonniére
•PIP joint flexes
 and DIP extends
•Central slip
 disrupts
•Lateral bands
 sublux volarly
     Office Management
•Boutonniére:
 dynamic splint
•Swan neck:
 figure ‘8’ splint
 (silver ring)
         How We Treat
•Swan neck
 –Indications:
  flexible joint
         How We Treat
•Boutonniére
 –Indications:
  flexible joint
         PIP Arthritis
•Arthrodesis
 versus
 Arthroplasty?
      PIP Arthroplasty
•Indications:
 –Pain
 –AROM < 45°
         Hand Arthritis
• Osteoarthritis: Clinical Presentation
  – DIP: Heberden’s nodes and mucous cysts
  – PIP: Bouchard’s nodes
  – MCP: rare
  – Basal thumb joint CMC/STT/Pantrapezial
  – Wrist: SLAC
Mucous Cyst




         • Do not
           aspirate!
      Mucous Cyst
• How We
  Treat
          PIP Arthritis
• Arthrodesis
  versus
  Arthroplasty
 Thumb Basal Joint Arthritis
• CMC
• Pantrapezial
• STT



     CMC     STT   Pan T
      Office Treatment
•CMC
 Arthritis
 –Opponens
  Splint
 –Injection
       How We Treat
•CMC Arthroplasty
       How We Treat
•CMC Arthroplasty
           STT Arthritis
• Office Treatment
  – Opponens
    splint
  – NSAID
  – Steroid inject
           STT Arthritis
• Office Treatment
  – Opponens
    splint
  – NSAID
  – Steriod inject
           STT Arthritis
• How We Treat
 – STT Arthrodesis
 – Radial Styloidectomy
         SLAC Arthritis
• Office Treatment
  – Wrist Splint
  – NSAID            Stage 1   Stage 2
  – Steroid inject




                     Stage 3   Stage 4
          How We Treat
• SLAC
  – I: Styloidectomy
  – II & III: 4-Bone   Stage 1   Stage 2
    Fusion
  – IV: Total Wrist
    Fusion

                       Stage 3   Stage 4
4-Bone Fusion
4-Bone Fusion




Preoperative   Postoperative
    Radiocarpal Arthritis
• Office Treatment
  – Wrist Splint
  – NSAID
  – Steroid Inject
         How We Treat

• Total Wrist
  Arthrodesis

								
To top